Provider Demographics
NPI:1134592116
Name:JONES, ANTHONY L
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 NE JACKSONVILLE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-6528
Mailing Address - Country:US
Mailing Address - Phone:386-243-8683
Mailing Address - Fax:386-438-5931
Practice Address - Street 1:542 NE JACKSONVILLE LOOP
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-6528
Practice Address - Country:US
Practice Address - Phone:386-243-8683
Practice Address - Fax:386-438-5931
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7004343172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver